gastrins and Peptic-Ulcer-Perforation

A 61-year-old woman was referred to our hospital for a double balloon endoscopy (DBE) examination of small intestine. She had undergone laparotomy for a perforated ulcer of the 3rd portion in the duodenum 3 years prior to this admission. Esophagogastroduodenoscopy at the previous hospital revealed multiple ulcers in the 2nd and 3rd portions in the duodenum. DBE revealed multiple ulcer scars in the proximal jejunum. Zollinger-Ellison syndrome was suspected from the distribution of the ulcers and scars. Serum gastrin was high and a selective arterial calcium injection test showed a step up of gastrin level only in the gastroduodenal artery area. We diagnosed a gastrinoma located on the ventral side of the 2nd portion of the duodenum from imaging studies. The tumor was extirpated and histologically found to be a neuroendocrine tumor in a lymph node. Serum gastrin level decreased to the normal range a day after surgery.

Topics: Biomarkers, Tumor; Diagnostic Imaging; Duodenal Ulcer; Endoscopy, Digestive System; Female; Gastrins; Humans; Middle Aged; Peptic Ulcer Perforation; Time Factors; Zollinger-Ellison Syndrome

Topics: Anemia, Hypochromic; Body Weight; Bone Diseases; Chronic Disease; Diarrhea; Dumping Syndrome; Duodenal Obstruction; Duodenal Ulcer; Female; Follow-Up Studies; Gastrectomy; Gastric Juice; Gastric Mucosa; Gastrins; Histamine; Humans; Insulin; Male; Methods; Pentagastrin; Peptic Ulcer; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Postoperative Complications; Recurrence; Stomach Ulcer; Vomiting

Topics: Diarrhea; Drainage; Dumping Syndrome; Duodenal Ulcer; Female; Gallbladder; Gastric Juice; Gastrins; Gastrointestinal Hemorrhage; Gastrointestinal Motility; Humans; Intestine, Small; Male; Pancreas; Peptic Ulcer Perforation; Postoperative Complications; Pyloric Antrum; Pyloric Stenosis; Pylorus; Recurrence; Stomach; Stomach Ulcer; Vagotomy

Topics: Abdomen; Duodenal Diseases; Duodenal Neoplasms; Duodenal Ulcer; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagitis; Esophagoplasty; Esophagus; Female; Gastrins; Gastrointestinal Hemorrhage; Hernia, Diaphragmatic; Humans; Male; Peptic Ulcer; Peptic Ulcer Perforation; Postoperative Complications; Rupture, Spontaneous; Stomach Diseases; Stomach Neoplasms; Stomach Ulcer; Stress, Psychological; Vagotomy

Topics: Alcohols; Aspirin; Duodenal Ulcer; Female; Gastric Mucosa; Gastrins; Humans; Male; Parasympatholytics; Peptic Ulcer; Peptic Ulcer Perforation; Sex Factors; Steroids; Stomach Ulcer; Stress, Physiological; Stress, Psychological; Time Factors

In a prospective randomized clinical trial, gastric acid secretion was compared in patients after simple closure, proximal gastric vagotomy with closure, or truncal vagotomy with pyloroplasty performed for perforated duodenal ulcer. The basal and pentagastrin- and insulin-stimulated acid outputs were similar after either proximal gastric or truncal vagotomy; they were also comparable with the postoperative acid values after corresponding procedures performed electively for chronic duodenal ulcer. Conversely, the basal and maximum acid outputs after simple closure of perforation were no different from the preoperative acid outputs of a group of duodenal ulcer patients matched for age and sex. The efficacy of acid reduction by emergency proximal gastric and truncal vagotomy was shown by the respective ulcer recurrence rate of 3% (1/34) and 6% (2/32) compared with 43% (15/35) after simple closure (p less than 0.01). Acid secretory data and serum gastrin levels did not predict ulcer relapse in patients after simple closure of perforation.

Topics: Adult; Clinical Trials as Topic; Duodenal Ulcer; Emergencies; Female; Gastric Acid; Gastrins; Humans; Male; Middle Aged; Peptic Ulcer Perforation; Postoperative Period; Prognosis; Prospective Studies; Pylorus; Random Allocation; Recurrence; Vagotomy; Vagotomy, Proximal Gastric

For treatment of giant perforated peptic ulcers, we hypothesized that partitioning of the gastric body instead of the antrum would prevent hypergastrinemia and minimize ulcerogenic risk. By maintaining part of the acid-secreting gastric body in continuity with the excluded distal stomach, gastrin-secreting cells in the antrum would still be inhibited by gastric acid secretion from the gastric body.. We studied (1) gastric body partition with gastrojejunostomy in 8 critically ill patients with giant perforated peptic ulcers and (2) the influence of gastric partition on serum gastrin in 18 dogs with gastric antral partition + gastrojejunostomy, or gastric body partition + gastrojejunostomy, or gastrotomy.. No patient developed major postoperative complications. Serum gastrin levels were normal in 6 patients but showed an abnormal increase in 2 patients 1 month after gastric body partition. Serum gastrin levels had returned to the normal range at postoperative follow-up after 2 years. In the animal study, serum gastrin levels and the number of G-cells in the excluded antrum and acid-secreting parietal cells in the gastric body were increased when evaluated on day 60 postoperatively or after antral partition, compared with preoperative data in the same group. These changes did not occur in the group undergoing partition of the gastric body and the group undergoing gastrostomy. Postoperative serum gastrin levels, and the number of G-cells and parietal cells also was significantly greater in the antral partition group than in the other 2 groups. No ulcer was found in any dog in the gastric body partition and gastrostomy groups, but ulcers occurred in 4 dogs in the antral partition group, all of whom died of ulcer perforation.. Gastric body partition + gastrojejunostomy is a simple, dependable procedure for patients with perforated giant peptic ulcers. This procedure does not require extreme expertise and can be performed in a very short time, even by a trainee general surgeon in emergency.

Topics: Adult; Aged; Animals; Digestive System Surgical Procedures; Dogs; Gastrins; Humans; Models, Animal; Peptic Ulcer; Peptic Ulcer Perforation; Postoperative Complications; Radiography; Recurrence; Risk Factors

The Zollinger-Ellison syndrome consists of severe peptic ulceration, acid hypersecretion, and islet tumors known as gastrinomas. The discovery of gastrinomas in unusual locations such as lymph nodes, bones, ovaries, and the liver poses a diagnostic dilemma as to whether the tumor is primary or metastatic. Here we present a case of a primary gastrinoma within a lymph node.

Topics: Abdominal Pain; Aged; Biopsy; Gastrinoma; Gastrins; Humans; Jejunum; Lymph Nodes; Male; Peptic Ulcer Perforation; Treatment Outcome; Zollinger-Ellison Syndrome

Topics: Adolescent; Biopsy; Diagnosis, Differential; Duodenal Ulcer; Endoscopy, Gastrointestinal; Gastrinoma; Gastrins; Hepatectomy; Humans; Liver; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Pancreatectomy; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Reoperation; Splenectomy

Topics: Acute Disease; Adolescent; Adult; Duodenal Ulcer; Gastric Juice; Gastrins; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Recurrence; Reference Values

Serum concentration of gastrin was measured before and after renal transplantation in 97 consecutive patients in order to assess possible correlations to gastrointestinal bleeding, allograft function, or graft rejection. In patients with transient signs of allograft rejection (N = 29) or upper gastrointestinal bleeding (N = 12) there was a nonsignificant trend towards higher postoperative gastrin levels, and in patients in whom the graft was removed (N = 29), this tendency was more pronounced (p = 0.06). The study demonstrated that monitoring of serum concentrations of gastrin following renal transplantation is of little clinical value. However, increased gastrin levels in serum may indicate that graftectomy may be the ultimate result.

Topics: Cadaver; Cimetidine; Female; Gastrins; Gastrointestinal Hemorrhage; Graft Rejection; Humans; Immunosuppressive Agents; Intraoperative Period; Kidney Transplantation; Male; Peptic Ulcer Perforation; Predictive Value of Tests

Topics: Duodenal Ulcer; Gastric Acid; Gastrins; Humans; Insulin; Peptic Ulcer Perforation

This paper reports a personal experience in the management of 45 patients with recurrent ulcer after gastric surgery. Inadequate acid reduction was the major cause of ulcer recurrence and treatment was by further acid reduction. Revisional surgery was performed in 23 patients (including a patient with a gastro-jejuno-colic fistula) with one mortality. Preliminary results of therapy with histamine H2-receptor antagonists have been encouraging and there appears to be a reduced need for re-operation in these patients in recent years. Less common causes of ulcer recurrence include retained suture material (2 cases) and the Zollinger-Ellison syndrome (2 cases). The incidence of post-surgical ulcer recurrence may be reduced by: improved surgical techniques, particularly in the performance of vagotomy, and avoidance of operations without acid reducing procedures e.g., gastro-jejunostomy without vagotomy; wider use of emergency ulcer curative surgery for perforated peptic ulcer. Experience at two local centres has been that this is a safe procedure in selected patients, there being no mortality in 58 cases. Routine screening of peptic ulcer patients for the Zollinger-Ellison Syndrome by measuring the serum gastrin level facilitates early diagnosis of the condition, thus forestalling gastric surgery and the inevitable recurrent ulceration.

Topics: Combined Modality Therapy; Duodenal Ulcer; Female; Gastrectomy; Gastrins; Histamine H2 Antagonists; Humans; Male; Middle Aged; Pentagastrin; Peptic Ulcer; Peptic Ulcer Perforation; Recurrence; Vagotomy; Zollinger-Ellison Syndrome

Topics: ABO Blood-Group System; Adolescent; Adult; Aged; Duodenal Ulcer; Female; Gastric Acidity Determination; Gastrins; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Seasons

Two personal cases of Zollinger-Ellison syndrome (ZES) are described. Total gastrectomy (TG) was performed in the first case as an emergency measure, following acute peritonitis caused by a recurrence of ulcer, with perforation 27 days after the first gastric resection. The patients is in good health, though with persistently high blood gastrin levels. The second case was marked by a long history of recurrent ulcer, with two earlier gastric resections. Here, success was obtained by simply enucleating a small gastrinoma from the head of the pancreas in view of the arteriographic evidence. The patient is in excellent health 2 1/2 yr after surgery with stable, normal blood gastrin. The recent literature and these cases suggest that surgery is the method of choice for ZES, its primary aim being the removal of gastrinomas, since these prove malignant in 60-100% of cases, and TG does not in any way inhibit their growth, as was once supposed. Blood gastrin values permit early diagnosis and postoperative monitoring, while arteriography and transhepatic portal catheterisation constitute a useful guide to the location of the tumour. Hyperchlorhydria can be effectively controlled with H2 receptor inhibitors, both in the preoperative diagnostic stage, and after surgery in the event of failure. TG offers the best results in over 60% of cases, when the tumours is multifocal, widely metastasised, or undiscoverable.

Topics: Adult; Angiography; Female; Gastrectomy; Gastrins; Humans; Male; Middle Aged; Peptic Ulcer Perforation; Peritonitis; Postoperative Complications; Zollinger-Ellison Syndrome

Electron microscopic and specific immunofluorescent studies revealed enhanced hormonal activity of the antral part of the stomach manifested in hyperplasia of gastrin-producing cells in patients with duodenal ulcer. A relationship between the level of stimulated gastric secretion, number of gastrin-producing cells and their functional activity was established. No correlation was found between the values of acidity and levels of basal and stimulated gastrin or the dependence of the latter parameters on the number and functional activity of gastrin-producing cells.

Topics: Adolescent; Adult; Duodenal Ulcer; Female; Gastric Mucosa; Gastrins; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Pyloric Antrum

Vagal activation produces a gastric acid secretory response by direct nervous stimulation of the parietal cell area and, at least in dogs, by gastrin released mainly from the antrum. In duodenal ulcer (DU) patients antrectomy reduces the acid response to sham feeding slightly more than the maximal acid output in response to pentagastrin, indicating that an antral factor contributes to the acid secretion induced by sham feeding. The marked acid response to sham feeding in antrectomized patients suggests that the direct nervous stimulation of the acid-secreting glands is the predominating stimulus in the vagal activation of acid secretion in man. In the present study vagal activation has been induced by adequate and modified sham feeding and insulin hypoglycemia in DU patients and healthy subjects. The acid response to adequate and modified sham feeding amounted to about 50% of the peak acid output in response to pentagastrin and corresponded to the acid response to an insulin dose of 0.1 U/kg b.w. Modified sham feeding seems to be a simple method of inducing physiological vagal activation of acid secretion. Sham feeding for 15 min increased only insignificantly the plasma concentrations of total gastrin immunoreactivity or heptadecapeptide gastrin. Prolonged sham feeding during intragastric neutralization or sham feeding after proximal gastric vagotomy did not significantly increase the plasma gastrin concentrations. Sham feeding is obviously a poor stimulus for release of gastrin in man. Either release effect of very small amounts of gastrin-17 or release of non-established gastrins may explain the biological effect of an antral factor. Pretreatment with benzilonium, an anticholinergic drug with minimal cerebral actions, increased the gastrin concentration after sham feeding in about half the experiments. This heterogeneous effect supports a non-cholinergic vagal release of gastrin and a cholinergic inhibition of gastrin release but also indicates a complex interaction at the level of the gastrin cells during vagal activation. Evidence for an inhibitory vagogastrone mechanism in DU patients has been found but its effect is weak and transient. Proximal gastric vagotomy abolished the acid responses to both insulin hypoglycemia and sham feeding, in accordance with the view that the direct nervous excitation of the acid-secreting glands is the predominating stimulus in the vagal activation of gastric acid secretion in man. Atropine in low doses or benzilonium

Topics: Adult; Aged; Animals; Dogs; Duodenal Ulcer; Duodenum; Ethics, Medical; Food; Gastric Juice; Gastrins; Humans; Insulin; Male; Middle Aged; Pentagastrin; Peptic Ulcer Perforation; Pyloric Antrum; Receptors, Cholinergic; Secretory Rate; Vagotomy; Vagus Nerve

Retained gastric antrum was evaluated in six dogs, and diagnostic methods correlated with histopathology. Secretin and calcium infusion did not significantly alter circulating gastrin levels. 99 mTc scanning was uniformly positive and did not depend on the presence of parietal cells. The failure to consistently develop hypergastrinemia and the absence of gastrin cell hyperplasia suggest that factors other than gastrin may be implicated in the recurrent ulceration seen with retained antrum.

Topics: Animals; Calcium; Dogs; Gastrectomy; Gastrins; Peptic Ulcer Perforation; Postoperative Complications; Pyloric Antrum; Radionuclide Imaging; Secretin; Technetium

Gastroduodenal ulceration occurred in 45 patients during the post-transplantation period in a series of 500 transplantations of 434 patients. The mortality rate of this complication was high, 42%. Bleeding and perforation were the main problems. These complications occurred frequently during treatment for acute rejection. Present day prophylaxis, which is based on the use of antacids, seems to be inadequate for controlling these complications. Other possibilities for reducing the incidence of gastroduodenal ulceration in transplant patients are discussed. Since increased serum gastrin concentrations are often observed in these patients, prophylactic treatment should be based on preoperative evaluation of gastric secretion and serum gastrin determinations. The new histamine (H2) blocking agents should be evaluated in these patients.

Topics: Cimetidine; Duodenal Ulcer; Gastrins; Histamine H2 Antagonists; Humans; Kidney Transplantation; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Stomach Ulcer; Transplantation, Homologous

What is considered to represent the fourth case of perforated jejunal ulcer in association with the Zollinger-Ellison syndrome reported in the literature is discussed. Although documented in the original paper by Zollinger and Ellison, this remains a notably rare complication. Generalized peritonitis and related pathophysiological phenomena make initial definitive correction of the ulcer diathesis an extremely riskly undertaking and ill-advised. We submit that primary ulcer resection followed by total gastrectomy when the patient becomes a more suitable operative risk is the preferred method of management. The literature would appear to support this clinical view.

Topics: Adenoma, Islet Cell; Duodenal Neoplasms; Gastrectomy; Gastrins; Humans; Jejunum; Male; Middle Aged; Peptic Ulcer Perforation; Zollinger-Ellison Syndrome

Topics: Animals; Diarrhea; Dogs; Dumping Syndrome; Gastric Juice; Gastrins; Gastrointestinal Motility; Humans; Insulin; Peptic Ulcer; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Postoperative Complications; Pylorus; Rabbits; Recurrence; Secretory Rate; Stomach; Vagotomy

Topics: Adenoma; Adult; Aged; Blood Glucose; Diazoxide; Duodenal Ulcer; Female; Gastrectomy; Gastrins; Glucagon; Hormones, Ectopic; Humans; Hyperparathyroidism; Hypoglycemia; Insulin; Insulin Secretion; Lymphatic Metastasis; Male; Middle Aged; Multiple Endocrine Neoplasia; Pancreatectomy; Pancreatic Neoplasms; Parathyroid Neoplasms; Peptic Ulcer Perforation; Splenectomy; Zollinger-Ellison Syndrome

Topics: Adult; Aged; Carcinoid Tumor; Cholestasis; Duodenal Neoplasms; Duodenal Obstruction; Duodenal Ulcer; Female; Gastrins; Gastrointestinal Hemorrhage; Histamine Release; History, 19th Century; History, 20th Century; Humans; Insulin; Insulin Secretion; Male; Middle Aged; Neoplasm Metastasis; Peptic Ulcer Perforation; Peptides; Prognosis; Serotonin

A patient with a multiple-hormone-producing islet cell carcinoma, who had previously been successfully treated with streptozotocin, was given three further infusions of this drug because of the redevelopment of gastric hypersecretion. Although some evidence of damage to the gastrinsecreting cells was obtained, the fasting plasma gastrin was not significantly altered and the patient died from a perforated duodenal ulcer. Serum insulin levels were considerably reduced and the patient became mildly diabetic but the main complication of treatment was a severe though reversible renal tubular defect. At necropsy considerable quantities of gastrin, but low levels of insulin and glucagon were extracted from a tumour metastasis.

Topics: Acetoacetates; Adenoma, Islet Cell; Antibiotics, Antineoplastic; Autopsy; Blood Glucose; Diabetes Insipidus; Duodenal Ulcer; Female; Gastric Juice; Gastrins; Glucagon; Glucosamine; Humans; Insulin; Kidney Tubules; Lactates; Liver Neoplasms; Middle Aged; Mutagens; Neoplasm Metastasis; Nitroso Compounds; Nitrosourea Compounds; Peptic Ulcer Perforation; Pyruvates; Urea